ASVMEB Complaint 22-26 In re: Juli Maher

ARIZONA STATE VETERINARY MEDICAL EXAMINING BOARD
1740 W. ADAMS ST., SUITE 4600, PHOENIX, ARIZONA 85007
PHONE (602) 364-1PET (1738) FAX (6@2) 3641039
VETBOARD.AZ.GOV

COMPLAINT INVESTIGATION FORM

if there is an issue with more than one veterinarian please file a-
separate Complaint Investigation Form for each veterinarian |

PLEASE PRINT OR TYPE

FOR OFFICE USE ONLY

Date Received: Sept, A b, LOL Case Number: 2A -ly

A. THIS COMPLAINT IS FILED AGAINST THE FOLLOWING:
Name of Veterinarian/CVT; Juli Maher
Premise Name: Casa Grande Animal Hospital
Premise Address: 1645 N Pinal Ave,
City: Casa Grande State; AZ Zip Code: 85122
Telephone: (520) 836-5979

B. INFORMATION REGARDING THE INDIVIDUAL FILING COMPLAINT?:
Name: [Taylor Haskin

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Home Telephon inn Cell (ele ae

“STATE LAW REQUIRES WE HAVE TO DISCLOSE YOUR NAME UNLESS WE CAN SHOW THAT DISCLOSURE WILL
RESULT IN SUBSTANTIAL HARM TO YOU, SOMEONE ELSE OR. THE PUBLIC PER A.R.S. § 41-1010. IF YOU HAVE
REASON TO BELIEVE THAT SUBSTANTIAL. HARM WILL RESULT IN DISCLOSURE OF YOUR NAME PLEASE PROVIDE
COPIES OF RESTRAINING ORDERS OR OTHER DOCUMENTATION.

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C. PATIENT INFORMATION (1):
Name: Sadie
Breed/Species: Lab & Pitbull Mix/Dog

Age: 12-13 yrs Sex: Female Color: Black Brindle
PATIENT INFORMATION (2):

Name:

Breed/Species:

Age: Sex: Color:

D. VETERINARIANS WHO HAVE PROVIDED CARE TO THIS PET FOR THIS ISSUE:
Please provide the name, address and phone number for each veterinarian.
Juli: Maher, John McWhirter, & Lorinda Fallini - 1645 N Pinal Ave. Casa Grande,
AZ, 85122, 520-836-5979
Jill Starks, Payton Bayless, Viktoria Pugnetti, Dana Caldwell, & Samuel Hollister -
86 W. Juniper Ave. Gilbert, AZ 85233, 480-497-0222

E. WITNESS INFORMATION:
Please provide the name, address and phone number of each witness that has
direct knoy
Carla Vireo

Attestation of Person Requesting Investigation

By signing this form, | declare that the information contained herein is true
and accurate to the best of my knowledge. Further, | authorize the release of
any and all medical records or information necessary .to complete the
investigation. of this case.

Signature:

Date: | / 14 |

F. ALLEGATIONS and/or, CONCERNS:
Please provide all information that you. feel is relevant to the comiplaint. This.
portion must be either typewritten orclearly, printed in ink. -

Details of: my concerns aré attached onthe following pages.

yor bias? -

_On September 1st, 2021, my mother, Carla Virgin, took Sadie to Casa Grande Animal
Hospital for an exam due to increased thirst, lethargy, vomiting, snoring/slight trouble breathing,
and decreased appetite. She also requested the examining Veterinarian to look at her right eye
due to slight irritation, a small growth on her left nostril, and weakness in right knee/hip. Dr.
McWherter concluded that the growth on her nostril was benign scarring from an old abscess,
weakness in knee/hip did not seem to be causing her pain and was most likely an old injury,
could not find any issues with her respiration, and that eye irritation was most likely due to
allergies. Sadie was given Depo Medrol and blood work was ordered by Dr. McWhirter.

On September 3rd, 2021, the blood work results were received by Casa Grande Animal
Hospital.

On September 4th, 2021, Dr. Maher reviewed blood work and called my mother, Carla
Virgin, with results. Dr. Maher stated that Sadie’s white blood cell count was very high and was
due to either a serious infection or cancer, but that she felt it was most likely cancer, and that
she was very sorry, and she never likes to deliver that kind of news to owners. Dr. Maher offered
to start Sadie on antibiotics in case of infection, we agreed, and picked up her medication. From
September 5th to September 6th, Sadie worsened even with administration of antibiotics. She
was experiencing vomiting, increased thirst, increased urination, decreased appetite,
snoring/trouble breathing, and lethargy.

On September 7th, due to Dr. Maher's belief that the underlying issue was cancer, my
mother inquired about how to go about getting her in to see a Veterinary Oncologist, and we
were instructed to call and make an appointment and they would send Sadie's records to them.
When | called Arizona Veterinary Oncologist they stated that we needed a diagnosis including
type and staging prior to making an appointment and were referred back to Casa Grande
Animal Hospital to seek a definitive diagnosis. We then called Casa Grande Animal Hospital to
request a prescription for fluids and anti nausea medication, and inquire about getting a
definitive cancer diagnosis Including type and staging. Casa Grande Animal Hospital informed
us that Dr. Maher was not in, but that they would ask Dr. McWhirter to review Sadie’s records to
sign off on a prescription and give further instruction on seeking a definitive cancer diagnosis
and staging. Dr. McWhirter signed off on prescription for IV fluids and anti nausea medication,
and left a voicemail message stating that after reviewing Dr. Maher’s notes, it appeared that she
was suggesting that Sadie have an ultrasound done. This was very concerning since the
suggestion of having an ultrasound done was not mentioned by Dr. Maher in her previous call
with results, So we called Casa Grande Animal Hospital back and asked to schedule an
ultrasound for the following day. The person who answered the phone stated that they would not
be able to get Sadie in for an ultrasound until Monday, September 13th. We stated that this was
unacceptable and she needed to be seen as soon as possible tomorrow morning because her
condition is worsening. | was instructed to bring her in the next moming, September 8th, at 9:30
am and an ultrasound would be performed as soon as a Vet was available.

On September 8th, we dropped Sadie off at Casa Grande Animal Hospital promptly at
9:30 am for her ultrasound. We received a call from Dr. Fallini around noon stating the

ultrasound showed that Sadie was experiencing pyometra, a severe infection of her uterus, and
would need emergency surgery to remove the infection. | agreed to have her proceed with
surgery. We received no follow up regarding Sadie's condition from Dr. Fallini, or any other Vet
or tech at Casa Grande Animal Hospital until my mother called them at 5:30 pm. After being
placed on hold multiple times, my mother was told that Dr. Fallini was unavailable at the
moment and that she would call her back with an update within the hour. Dr. Fallini called back
and stated that Sadie's surgery went well but that she was not recovering as quickly as she
would like to see and that her glucose levels were high. She stated that she would need to be
transferred to Arizona Veterinary Emergency & Critical Care Center in Gilbert for overnight
observation and continuation of fluids, antibiotics, pain medication, and insulin, since Casa
Grande Animal Hospital is not staffed overnight. We took Sadie to Arizona Veterinary
Emergency & Critical Care Center for further care immediately that night. After Dr. Bayless’
initial exam, she advised that she was most likely experiencing sepsis due to the length of time
she had the pyometra and that she would keep Sadie overnight for post-op care, pain meds,
antibiotics, and blood glucose monitoring.

During Sadie’s overnight stay, she developed anisocoria and two small ulcers were
noted in her right eye. After some research, | assume that these corneal ulcers were most likely
caused by the development of Sadie’s diabetic condition. Her diabetic condition which was
caused by the serious pyometra that was negligently overlooked and misdiagnosed by both Dr.
Maher and Dr. McWhirter. Due to this misdiagnosis, we were led in the wrong direction to seek
out care for Sadie, and she was denied the urgent care she needed. Sadie ultimately could
have died due to misdiagnosis and negligence at the hands of Dr. Maher and Dr. McWhirter.
She will now live with diabetes induced by this Infection for the rest of her life. My family has
incurred extensive emotional! distress due to this event. First, by being told that our beloved pet
has cancer, and trying to come to terms with that, just to be told she needs emergency surgery
and it isn't cancer at all. | have incurred extensive veterinary bills due to Dr. Maher and Dr.
McWhirter's negligence totaled at approximately $6,100, including prescriptions for Sadie's care
at home upon release from the Veterinary hospital.

Juli Maher, DVM, PhD
247 N Monterey Ct
AZ 85194

Response to complaint case number 22-26 re: Juli Maher, DVM
1. Narrative

On September 4, 2021, I was working at Casa Grande Animal Hospital (CGA), returning phone calls
for completed labwork for my patients and those of other doctors who were off that day.

I reviewed partial laboratory results for Sadie Virgin, which showed a very high white blood cell
(WBC) count and neutrophilia with the presence of band cells and metamyelocytes. At the time of the
phone call, the clinical pathology review of the CBC and the coccidioides titer, which are part of the
final report, were not present on the fourth. I do not remember if the chemistry panel results were in
Sadie’s chart when it appeared on my desk on September 4, 2021.

Due to the large increase in WBC numbers in this 12 year old pet, I called the owner and informed
them that her lab results revealed a very high WBC count, which could indicate a severe infection.
Another possibility in a pet this age was cancer, in my mind, due to the presence of metamyelocytes in
the periphery, a cell-type I’ve rarely seen reported on blood counts.

Based on a brief review- of her.chart.and Dr. McWhirter’s notation of Ain’t Doing Right (ADR):and her
low albumin levels, which meant to me that a plethora of disease, from chronic gastrointestinal to
hepatic to renal/genitourinary, could be present, I recommended an abdominal ultrasound to image the
abdominal organs for abnormalities. Until additional diagnostics or a recheck examination could. be
done, I prescribed: two antibiotics to cover a broad range:‘of bacterial pathogens and advised the owner
to start them the:same day. .

My expectation was that the owner would return for a recheck'examination, additional diagnostics, and
a progress report.with Dr. McWhirter when he was in the.office the following week or sooner if Sadie’s
condition worsened.

My handwritten notes in the chart are as follows:

*hypoalbuminemia * Elevated WBC count with Bands and metamyelocytes

PC (phone call) 11:50am —-SWO (Spoke with owner ) re.grossly elev (elevated) WBC. Concern .for
CANCER. Rec (recommend) start oral abtcs (antibiotics). Rec (recommend) Abd (abdominal) U/S
(ultrasound). VF (Valley fever titer) pending. MAH

Rx: Baytril (136mg, #15) 1.5 tabs'PO SID x 10:days.
Rx: Amoxi-Clav (625mg, #28) 1 BID x 14 days.

Regarding the: phone call on September'4, 2021 and the complaints assertion that I was sorry to deliver
that kind of news, I am distressed to tell every. owner that their pet is very ill; regardless of possible

causes. However, I did not examine Sadie myself and, having no direct knowledge of her actual
physical examination findings, do not believe ] intimated neoplasia as the only reason for the abnormal
results or Sadie’s symptoms. I prescribed two antibiotics covering a broad range of pathogens because
the results suggested that Sadie was experiencing a massive bacterial infection and that medical
treatment was needed as soon as possible. Only additional diagnostic testing or examinations could
pinpoint the source of the problem, in my experience. It is my sense that the owner focused on the
word cancer rather than infection, and acted according to their internal bias.

The first time I physically saw Sadie at CGAH was.during her ultrasound examination with Dr. Fallini,
where Dr. Fallini showed me the fluid filled uterine horns. Dr. Fallini removed the pyometra surgically
that day and monitored her condition post-operatively with her characteristic attention to detail and
patient comfort. I remember Dr. Fallini recommending to the owner, by phone call, to transfer Sadie to
AVECC Gilbert for overnight supportive care.

2. Copy of Sadie Virgin medical records

3. Typewritten transcript of Sadie’s medical records.

4. All laboratory reports

VICTORIA WHITMORE
- EXECUTIVE DIRECTOR -

DOUGLAS A. DUCEY
- GOVERNOR -

ARIZONA STATE VETERINARY MEDICAL EXAMINING BOARD
1740 W. ADAMS STREET, STE. 4600, PHOENIX, ARIZONA 85007
PHONE (602) 364-1-PET (1738) * FAX (602) 364-1039
VETBOARD.AZ.GOV

INVESTIGATIVE COMMITTEE REPORT

TO: Arizona State Veterinary Medical Examining Board

FROM: PM Investigative Committee: Adam Almaraz - Chair
Amrit Rai, DVM
Steven Dow, DVM
Gregg Maura
Justin McCormick, DVM

STAFF PRESENT: Tracy A. Riendeau, CVT - Investigations
Marc Hanis, Assistant Attorney General

RE: Case: 22-26
Complainant(s): Taylor Haskin
Respondent(s): Juli Maher, DVM (License: 74920)

SUMMARY: -APPLICABLE STATUTES AND RULES:
Complaint Received at Board Office: 9/16/21 Laws as Amended August 2018
Committee Discussion: 2/1/22 (Lime Green); Rules as Revised September
Board IIR: 3/16/22 2013 (Yellow).

On September 1, 2021, “Sadie,” a. 12-year-old female Labrador mix was presented to Dr.
McWhirter due to lethargy, increased thirst, anorexia and vomiting. The dog was examined; Dr.
McWhirter recommended blood work, administered the dog Depo-Medrol and the dog was
discharged.

On September 3, 2021, blood was collected for testing.

On September 4, 2021, Dr. Maher contacted the pet owner with the blood results. She
reported the dog had an infection and possibly cancer. She recommended started the “09 on
antibiotics and having an abdominal ultrasound.

On September 8, 2021, the dog had an abdominal ultrasound performed and was
diagnosed with a pyometra; surgery was performed. That evening the dog was transferred to
an emergency facility for continued care and monitoring of persistent hyperglycemia.

Complainant was noticed and did not appear.
Respondent was noticed and appeared.

22-26, JULI MAHER, DVM

The Committee reviewed medical records, testimony, and other documentation as described below:
e Complainant(s) narrative: Taylor Haskin
e Respondent(s) narrative/medical record: Juli Maher, DVM
e Consulting veterinarian(s) narrative/medical record: Arizona Veterinary Emergency & Critical Care
Center

PROPOSED ‘FINDINGS of FACT’:

1. On September 1, 2021, the dog was presented to Dr. McWhirter due to lethargy, increased
thirst, anorexia, and vomiting. Complainant's mother, Ms. Virgin, also reported that the dog
seemed to be snoring more and breathing with more effort. Additionally, the dog's eyes were
weeping more than usual, the right rear leg was weak, and there was a small mass near the
dog's left nostril.

2. Dr. McWhirter examined the dog and found a weight = 52.6 pounds, a temperature = 102.1
degrees, a heart rate = 120bpm, and a respiration rate = pant; BCS 6/9. The mass near the left
nostril was evaluated — scar, lipoma, tumor (benign vs malignant); the right rear leg lameness
was likely related to cranial cruciate ligament issue; and Dr. McWhirter could not appreciate
any respiratory issues at that time. He contacted Ms. Virgin to report his findings. Although he did
not find anything obvious, he suspected a metabolic or physiological issue was going on and
recommended blood work. Ms. Virgin declined the blood work at that time and approved the
steroid injection. The dog was administered Depo-Medrol 20mg SQ and was discharged.

3. On September 3, 2021, the dog was presented to the premises for blood collection. The dog
had a weight = 53.8 pounds, a temperature = 102.1] degrees, a heart rate = 120bpm, and a
respiration rate = pant.

4, Blood abnormalities were as follows:

GLUC 198 63-114
PHOS 6.7 2.5 -6.1
POTA 6.2 4-54
NA:K RATIO 23 28 — 37
CHLOR 103 108-119
AN.GAP 30 11-26

T. PRO 7.8 5.5 -7.5
ALBUM 2.4 2.7 -3.9
GLOBULIN 5.4 2.4 -4.0
ALB:GLOB RATIO 0.4 0.7-1.5
ALT 14 18-121
CREAT KIN 566 10 — 200
HEMO 13.2 13.4 — 20.7
MCHC 32.4 32.6 - 39.2
WBC 70.9 4.9-17.6
NEUTS 45.38 2.94 — 12.67
BANDS 10,635 0-170
METAMYELOCYTES 1.410 <=0
MONOS 9.93 0.13 - 1.15
PLATELETS 439 143 —448

Page 2

22-26, JULI MAHER, DVM

COCCI IgG Positive <1:2

5. On September 4, 2021, Dr. Maher called Ms. Virgin with the blood work results. She explained
that results indicated a severe infection and due to the dog's age, cancer was a possibility. Dr.
Maher stated that the presence of metamyelocytes in the periphery was a cell type she rarely
saw. She also stated that due to the low albumin levels, there could be many issues occuring —
chronic gastrointestinal disease, hepatic disease, renal disease, genitourinary disease — therefore
she recommended an abdominal ultrasound to look for any abnormalities. Dr. Maher
recommended starting the dog on two antibiotics:

a. Baytril 136mg, 15 tablets; give 1.5 tablets once a day for 10 days; and

b. Amoxi-Clav 625mg, 28 tablets; give 1 tablet twice a day for 14 days.

6. According to Complainant, Dr. Maher advised that the dog's high WBC was due to either a
serious infection or cancer, but that she felt it was most likely cancer. She offered to start the
dog on antibiotics, which was approved. Complainant picked up the medication and
administered them to the dog.

7. Dr. Maher stated that she does not believe that she intimated that neoplasia was the only
reason for the abnormal results or the dog's symptoms. She advised the pet owner that the dog
was experiencing a massive bacterial infection and treatment was needed as soon as possible.
Dr. Maher believes the pet owner focused on the word cancer rather than infection.

8. Complainant stated that the dog worsened over the next couple of days, despite
medications the medication being administered. Due to Dr. Maher's belief the dog had cancer,
Complainant called an oncologist — she was advised that she needed a definitive diagnosis
and staging prior to bringing the dog to them.

9. On September 7, 2021, Complainant called Casa Grande Animal Hospital to ask for fluids,
anti-tnausea medication and discuss how to diagnose the possible cancer. Dr. McWhirter
approved the request and stated that Dr. Maher recommended an abdominal ultrasound.
Complainant stated that she was upset because Dr. Maher did not mention the ultrasound. The
dog was dispensed:

a. LRS 1 liter (3), give 400 —- 500mLs SQ;

b. IV drip set;

c. Needles; and

d. Cerenia 60mg, 4 tablets; 1 tablet every 24 hours.

10. On September 8, 2021, the dog was presented to Dr. McWhirter's and Dr. Maher's associate,
Dr. Fallini for an abdominal ultrasound.

11. The dog was diagnosed with a pyometra, blood was tested and emergency surgery was
performed.

Page 3

22-26, JUL] MAHER, DVM

Test Results Reference Interval LOW NORMAL HIGH

ProCyte Dx (September 8, 2021 1:05 PM)

RBC 4.17 Mipl 565-887 LOW

HCT 24.9% 37.3-61.7 LOW

HGB 8.3 gidL 13.1-205 LOW

MCV 59.7 fL 616-735 LOW

MCH 22.3 pg 21.2-25.9

MCHC 37.3 g/dL 32.0 - 37.9

ROW 17.3 % 13.6-21.7

%RETIC 1.6%

RETIC 68.4 Kip 10.0 - 110.0

RETIC-HGB 26.0 pg 22.3 - 29.6

wec 70.15KipL ~505-16.76 HIGH

%NEU "65.6% :

%LYM "138% ‘si

%MONO * 19.6 %

%EOS 1.0%

%BASO 0.0 %

NEU "46.01KyL = -295-11,66 HIGH [TT
BAND * Suspected I

LYM ° 9.69 KiuL 105-5.10 HIGH

MONO * 13.74 KfaL 016-1.12 . HIGH

EOS 0.71 Kip 0.06 - 1.23

BASO 0.00 Kipt. 0.00 - 0.10

PLT 393 K/pl. 148 - 484

MPV 12.91. - 8.7 = 13.2

PDW 15.3 1 "91-194

PCT 0.51 % 014-0.46 HIGH

* Confirm with det plot and/or blood film review, !
1. Anemia without reticulocytosis - Likely non-regeneralive anemia; consider 1. Immature andor toxic neutrophils likely present - Consider h
pre-regeneralive enamia.
Catalyst Dx (September 8, 2021 1:13 PM)

GLU 578 mo/de 70 - 143 HIGH
CREA 2.7 mgfdL 05-18 HIGH
BUN 80 mg/dL 7-27 HIGH

BUN/CREA 30
TP : 6.2 g/dL 52-82

ALB 2.3 gidL 22-39

GLOB 3.9 gidL 25-45

ALB/GLOB 06

ALT 44 UN 10 - 125
ALKP 229 U/L 23-212 HIGH

12. Due to the dog's worsening condition and persistent hyperglycemia, it was recommended
the dog be transferred to an emergency facility. Complainant agreed and transferred the dog.

13. Later that evening, the dog was presented to Arizona Veterinary Emergency & Critical Care
Center (AVECCC) for hospitalization and supportive care. The dog remained hospitalized until
September 10, 2021. The dog was.diagnosed with diabetic ketosis, azotemia, comeal ulcers and
was likely septic due to the length of time the dog had the closed pyometra.

14. Complainant contends that the dog's condition was overlooked and misdiagnosed by
Dr. McWhirter and Dr. Maher.

COMMITTEE DISCUSSION:

The Committee discussed pyometras and that closed pyometras are more dangerous than
open pyometras. Once the patient begins vomiting and has an elevated WBC, it becomes an

emergency and surgery is needed.

Page 4

22-26, JULI MAHER, DVM

After the preliminary blood work was received on 9/4/21, the dog should have been brought
back for additional diagnostics.

The. Committee: discussed the depo-medrol injection could have exacerbated the dog's
subsequent diagnosed diabetes. They were concerned that a long acting steroid was
administered to the dog before having a diagnosis.

The Committee discussed that the hospital does not have protocols in place for sick animals
getting follow up. There were concerns with the passing of the case and no clear doctor in
charge of the case, which led to an unnecessary time lapse in the treatment of the dog. There
was a lack communication between doctors and to the pet owner on the seriousness of the
dog's condition.

There was concern with the treatment of the dog's eye. It was not known if Dr. McWhirter missed
something by not staining the eye or performing a tear test.

Based on the conversation with Dr. Maher, Complainant may have heard the word cancer and
only focused on that possible diagnosis. However, the Committee felt that it was the
veterinarians’ obligation to make recommendations and follow up with the dog's care. In this
case, the pet suffered based on the mishandling of the case. Dr. Maher did not realize the dog -
was an intact female. Complainant was the one who followed up on.the dog and initiated the :
ultrasound to pursue the dog's declining condition.

The Committee expressed concern with the premises itself and how case: management was
handled internally; neither. of the veterinarians that the complaint was filed ‘against is the -
responsible veterinarian for the premises.

COMMITTEE'S PROPOSED CONCLUSIONS of LAW:
The Committee concluded that possible violations of the Veterinary Practice.Act occurred.
COMMITTEE'S RECOMMENDED DISPOSITION:
Motion: It was moved.and seconded.the Board find:
ARS § 32-2232 (11) Gross negligence:
e Failure to identify the dog was an intact female and possibly. had a pyometra; :
e Failure to relay to the pet owner the. seriousness of the dog's blood results'and not
recommending the dog be brought back in for re-evaluation; and.
e Failure to communicate with her associates the seriousness of the dog's condition

ensuring proper follow up and care of the patient.

Vote: The motion was approved with a vote. of 5 to 0.

Page 5

22-26, JULI MAHER, DVM

The information: contained in this report was obtained from the: case file; which includes the
complaint, the respondent's response,. any consulting veterinarian or'witness input, and.any
other sources.used to gatherinformation for the investigation.

Tracy A: Riendeau, CVT

Investigative Division’ ‘ ; ; :
p an 7 “ = : ?
ir . 2 z. c 5
5 .Page'6

VICTORIA WHITMORE
EXECUTIVE DIRECTOR

DOUGLAS. A DUCEY
GOVERNOR

ARIZONA STATE VETERINARY MEDICAL, EXAMINING BOARD
17740 W. ADAMS STREET, STE. 4600, PHOENIX, ARIZONA 85007
PHONE (602) 364-1-PET (1738) ¢ FAX (602) 364-1039
VETBOARD.AZ.GOV

IN ACCORDANCE WITH § A.R.S. 32-2237(D): “IF THE BOARD REJECTS ANY RECOMMENDATION CONTAINED IN A
REPORT OF THE INVESTIGATIVE COMMITTEE, IT SHALL DOCUMENT THE REASONS FOR ITS DECISION IN WRITING.”

At the April 20, 2022 meeting of the Arizona State Veterinary Medical Examining Board, the Board
conducted an Informal Interview in Case 22-26, In Re: Juli Maher, DVM.

The Board considered the Investigative Committee Findings of Fact, Conclusions of Law, and
Recommended Disposition:

ARS § 32-2232 (11) Gross negligence:
e Failure to identify the dog was an intact female and possibly had a pyometra;
e Failure to relay to the pet owner the seriousness of the dog's blood results and not
recommending the dog be brought back in for re-evaluation; and
e Failure to communicate with her associates the seriousness of the dog's condition
ensuring proper follow up and care of the patient.

Following the informal interview with Respondent, the Board did not feel this incident rose to the
level of a violation and voted to issue Dr. Maher a Letter of Concern for failure to communicate
with associates the seriousness of the dog's condition and ensuring proper follow up care was
provided to the dog and failure to ensure the pet owner understood the severity of the dog's
blood work and immediate care was needed.

Respectfully submitted this ps" day of Tie , 2022.

Arizona State Veterinary Medical Examining Board

ead, Chair